Publication date: Jan 10, 2020
The number needed to treat or excise (NNT) is commonly used to measure the number of skin biopsies performed to detect one melanoma. The NNT for melanoma varies widely between clinical settings.
To provide a formal statistical comparison of the efficacy of melanoma detection between different clinical settings.
A systematic review and meta-analysis of all relevant observational studies on NNT in relation to melanoma was performed on MEDLINE. We performed a random effects model meta-analysis and reported NNTs with 95% confidence intervals (CIs). The subgroup analysis was related to clinical setting.
In all, 29 papers including a total of 398,549 biopsies/excisions were analyzed. The overall NNT was 9.71 (95% CI, 7.72-12.29): 22.62 (95% CI, 12.95-40.10) for primary care, 9.60 (95% CI, 6.97-13.41) for dermatologist, and 5.85 (95% CI, 4.24-8.27) for pigmented lesion specialists.
There is heterogeneity in data reporting and possibility of missing studies. In addition, the incidence of melanoma varies among clinical settings and could affect NNT calculations.
Specialists have the lowest NNT, followed by dermatologists, suggesting involving specialists in the diagnosis and treatment of pigmented skin lesions can likely improve patient outcomes.
Petty, A.J., Ackerson, B., Garza, R., Peterson, M., Liu, B., Green, C., and Pavlis, M. Meta-Analysis of Number Needed to Treat for Diagnosis of Melanoma by Clinical Setting. 25438. 2020 J Am Acad Dermatol.
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